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PubMed1981

Shifting from external to internal provision of mental health services in a health maintenance organization.

A health maintenance organization whose mental health services had been supplied under contract by two successive external providers changed in 1978 to in-house provision of most services for both HMO and fee-for-service patients. The changeover necessitated a greatly enlarged staff, development of a treatment philosophy and utilization review procedures, and establishment of good cmmunications with external providers who supplied inpatient services. One objective of the change to in-house services was to further reduce hospital admissions and hospitalization costs; comparisons of admissions and costs over a five-year period before and after the change indicated substantial reductions in both areas.

Fees and Charges↗
PubMed1986

Costs and benefits of medical student training to a health maintenance organization.

As health maintenance organizations (HMOs) and managed health care systems expand, they represent an increasing potential as sites for medical student teaching. Considerable difference of opinion exists about the impact of medical training on these prepaid delivery systems. This study presents a methodology for estimating the subjective and objective costs and benefits of medical student training to an independent staff model HMO with a long-standing training program. Data are derived from a provider survey, a consumer survey, and patient visit logs. Principal subjective benefits include increased perceived quality of care, improved patient satisfaction, and enhanced provider education and joy of practice. Objective impacts include a decrease in productivity of 1.1 patient visits per half day and direct physician teaching labor of 46.8 minutes per half day. Applying this methodology to the specific program of ten courses gives rise to a figure of $180 000 ($16 900 per full-time equivalent student per year) for the "opportunity cost" of medical student training to the HMO. Rules of thumb are developed for application of this method prospectively to new programs in similar relationships between staff model HMOs and academic medical centers.

Cost-Benefit Analysis↗
PubMed2000

Lupus nephritis outcomes: health maintenance organizations compared to non-health maintenance organizations.

OBJECTIVE: Patients with systemic lupus erythematosus (SLE) in USA increasingly have their care centered in health maintenance organizations (HMO). We examined whether HMO and non-HMO SLE patients with renal involvement, who had the same university rheumatologist, differed in their utilization of health care or renal outcomes. METHODS: Consecutive patients with SLE with renal involvement (n = 24), 10 enrolled in an HMO, 14 not, were studied. Laboratory values were prospectively determined. RESULTS: At the first visit to the rheumatologist, there was no significant difference between HMO and non-HMO patients in laboratory values. There was no difference in the 2 groups in the final prednisone dose (HMO 12 mg vs non-HMO 15.9 mg) or use of azathioprine (20% vs. 57%; p = 0.07) or cyclophosphamide (60% vs. 57%). The serum creatinine was higher in the HMO patients (HMO 1.1 mg/dl vs. non-HMO 0.78 mg/dl; p = 0.05). No difference was found in the number of rheumatology visits. There was a significant difference in the number of communications from the rheumatologist to the HMO versus the HMO to the rheumatologist (p = 0.026). CONCLUSION: Other than the serum creatinine, there are no differences in the treatment or renal outcomes for HMO compared to non-HMO patients with SLE seeing the same rheumatologist. There is a potential barrier in physician communication, however, with the majority of communications going from the rheumatologist to the HMO provider.

Adult↗
PubMed1980

The competitive response of Blue Cross to the health maintenance organization.

The health maintenance organization (HMO) is an alternative to the traditional fee-for-service health care system in the United States. Other studies have shown that the HMO reduces hospital utilization and offers greater benefit packages than fee-for-service. This paper tests whether the presence of HMO's provides effective competitive pressure on Blue Cross, the largest insurer of hospital costs. The cross sectional regression analysis supports the hypotheses that Blue Cross has reduced hospital utilization and increased benefit packages in response to HMO competition. Consequently, competitive forces are shown to be operative in at least one area of health care.

Blue Cross Blue Shield Insurance Plans↗
PubMed1978

The external provision of Health Maintenance Organization mental health services.

The author describes the three ways mental health services may be provided in a health maintenance organization (HMO)--by an internal department of psychiatry, by one or more unrelated external autonomous care providers, or by an external autonomous group of providers. He proposes that the latter type is the best model, offering many of the advantages of the internal department while delivering more personalized, higher quality care at lower cost to the HMO. However, certain conditions must exist, including convenient location, regular conferences with other HMOR physicians, and the provision of educational and preventive services, if the superiority of this model is to be maintained.

Cost-Benefit Analysis↗
PubMed1981

Requirements for a health maintenance organization--Public Health Service. Final regulations.

These regulations amend the requirements for the operation of federally qualified health maintenance organizations (HMOs) regarding the disclosure of information by HMOs to members, potential members, and employers. These amendments are made to coordinate the requirements of the Employee Retirement Income Security Act of 1974 (ERISA) and Title XIII of the Public Health Service Act (the Act) so as to avoid any duplicative or otherwise unnecessary requirements that might result from the interaction of these laws.

Confidentiality↗
PubMed1983

Health maintenance organizations--Public Health Service. Interim rule with request for comments.

This notice amends the Public Health Service regulations on Federal qualification of health maintenance organizations [HMOs]. The purpose is to provide greater flexibility for already existing prepaid health care delivery systems to become transitionally qualified HMOs. Adoption of this amendment wil allow entities operating these systems to satisfy the requirement that basic health services be provided to members by demonstrating that members enrolled at the time of transitional qualification receive hospital services or are insured for hospital services through an arrangement not made by the HMO.

Health Maintenance Organizations↗
PubMed1981

Qualification of health maintenance organizations: Public Health Service. Notice of proposed rulemaking.

This notice proposes to amend the Public Health Service regulations on the qualification of health maintenance organizations (HMOs). These amendments are proposed as a result of the HMO Amendments of 1978 (Pub. L 95-559) and the Secretary's experience with he interim regulations published on June 8, 1977. The proposed changes would (1) modify the appeal procedures followed by the Secretary when an entity is denied qualification, (2) revise the requirements for the signing of assurances by qualified HMOs, (3) clarify how the Secretary treats information submitted by an applicant for qualification which may be requested under the Freedom of Information Act, and (4) make other clarifying and technical revisions regarding the qualification of HMOs.

Health Maintenance Organizations↗
PubMed1980

Public Health Service--Health maintenance organizations; employees' health benefits plans. Final regulations.

This rule amends the Public Health Service regulations by setting forth revised requirements for certain employers, States, and political subdivisions of States to include in any health benefits plans offered to their employees the option of membership in qualified health maintenance organizations (HMOs). These changes are made as a result of public comments received on the notice of proposed rulemaking (NPRM) published on July 18, 1979. Certain minor technical and editorial changes have also been made.

Health Benefit Plans, Employee↗
PubMed1982

Health maintenance organizations; reestablishment of compliance by Kaiser Foundation Health Plan, Inc.: Public Health Service. Notice, continued regulation of health maintenance organizations.

On December 4, 1981, the Office of Health Maintenance Organizations (OHMO) notified Kaiser Foundation Health Plan, Inc. that Kaiser-Georgetown Community Health Plan, Inc.), (formerly Georgetown University Community Health Plan, Inc.), 4200 Wisconsin Avenue, NW., Suite 300, Washington, D.C., a federally qualified health maintenance organization (HMO), had successfully reestablished compliance with its assurance to the Secretary that it would maintain a fiscally sound operation. This determination took effect on December 1, 1981.

District of Columbia↗
PubMed1980

Public Health Service--Information regarding requirements for health maintenance organizations. Notice, information regarding requirements for qualified health maintenance organizations.

This notice contains information relating to the requirements for federally qualified health maintenance organizations (HMOs) as set out in Title XIII of the Public Health Service Act (the Act), as amended, and its implementing regulations at 42 CFR Part 110. This information, which includes a number of interpretive rulings, is being published in response to significant questions that have been raised regarding those requirements.

Health Maintenance Organizations↗